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Outcomes for Very Preterm Infants Across Health Systems
Jeannette A Rogowski1, Lucy Greenberg2, Erika M Edwards2,3,4
1College of Health and Human Development, The Pennsylvania State University, University Park.
Insights
Variation exists in care for very preterm infants across US health systems. A 2-percentage point mortality difference and 12-day length of stay variation highlight opportunities for quality improvement in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Health Services Research
- Pediatrics
Background:
- Most very preterm infants in the US receive care within multihospital health systems due to consolidation.
- The extent of outcome and length of stay variation for very preterm infants across these systems is largely unknown.
Purpose of the Study:
- To evaluate variations in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).
Main Methods:
- A cross-sectional study analyzed data from 224 US health systems in the Vermont Oxford Network between January 2021 and December 2022.
- Included 38,501 very preterm infants receiving neonatal intensive care unit (NICU) care.
- Multilevel logistic and linear models estimated adjusted mortality rates and length of stay.
Main Results:
- The highest performing quartile of systems had a mean adjusted mortality rate of 7.8%, compared to 9.8% in the lowest performing quartile.
- Mean adjusted length of stay for surviving infants ranged from 78 days in the highest performing quartile to 90 days in the lowest.
- A 2-percentage point difference in mortality and a 12-day difference in length of stay were observed between system quartiles.
Conclusions:
- Significant, potentially clinically meaningful variations in mortality and length of stay exist for very preterm infants across US health systems.
- Opportunities are present for health systems to enhance quality of care at the system level, aiming to reduce mortality and resource utilization.
Importance:
As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.
Objective:
To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).
Design, Setting, And Participants:
This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.
Exposure:
Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.
Main Outcomes And Measures:
Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.
Results:
The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.
Conclusions And Relevance:
In this cross-sectional study of very preterm infants, there was a 2-percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.
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